Strengthening Health Financing in Partner Developing Countries. Outline

Transcription

1 Strengthening Health Financing in Partner Developing Countries Ravi P. Rannan-Eliya Global Action for Health System Strengthening G8 Hokkaido Toyako Summit Follow-Up Seminar Imperial Queen s Park Hotel, Bangkok January 27, 2009 Outline Why health financing should be central to G8 agenda Critical policy issues in health financing Challenges for G8 support Recommendations for G8 action Global Financial Crisis Next Steps 1

2 Why should global health be a priority for the G8? MDGs Progress least for health MDGs Alignment of health agenda with human security and social protection agendas of Japan, EU and USA Financial risks of ill-health Transnational risks to health in interconnected world from failures in public health Avian flu, melamine Global financial crisis 2 Some critical issues Impoverishing impact of out-of-pocket payments for health 100 million pushed into poverty each year Directly linked to reliance on out-of-pocket financing Failure to translate more money into better health progress More money does not mean more health Significance of funding gap as a constraint Global targets of $30 per capita unlikely Shortfall does not mean MDGs/universal coverage cannot be achieved 3

3 Increasing funding for health - both ODA and domestic 4...but no improvement in MDGs 4, 5 5

4 Limitations of focusing only on global targets for health spending Unlikely to be achieved A shortfall should not mean that MDGs and universal coverage cannot be reached Global estimates make no allowance for efficiency gains Country evidence that MDGs and universal coverage are feasible in LICs for less than $10 per capita in public spending Historical evidence from Africa and Asia that service coverage can be doubled without increases in level of public financing effort 6 7

5 Why health financing policies in countries matter Health financing key control knob available to policy makers Health financing critical to improve:! Risk protection! Coverage of services - Health outcomes & Equity! Efficiency of service delivery 8 What do we know about health financing? To improve risk protection and to ensure coverage of the poor financing must shift from out-of-pocket to public financing Public financing Tax financing Social health insurance plus tax financing * Does not imply that private financing will not contribute, but only that it cannot substitute * Only tax-financed, public delivery has worked at low income - SHI only successful in middle or high-income countries 9

6 What we don t know is the How? How have countries made tax-financing, public delivery work in low income settings? How have countries managed the public-private mix in financing effectively when country capacity is weak? How did countries expand social insurance to rural/poor populations? How do some countries achieve universal coverage and MDGs at low cost? 10 Challenges for G8 ODA is only effective when countries have sound policies and institutions Conditionality only works if govts are committed to policies Donors cannot impose good financing policy, but most countries still lack capacity to develop and own policies Technical consensus that public financing is key, but confusion in G8 messages Lack of clarity on the centrality of public financing Conflict over SHI and taxation, particularly amongst EU partners Harmonizing vertical funds with HSS strategies 11

7 Country ownership of better policy Global evidence not effective if countries lack ownership over process of acquiring knowledge Politics and leadership are critical, but national technical capacity is necessary Capacity to learn and analyze Capacity to assess policy options and evidence Technical capacity was critical to Japan, Thailand, Mexico, but Africa? 12 Recommendations for G8 1. Complement support for increasing money for health with added support for improving the value of health spending through support for better country-led health financing and systems policies. 2. Translate technical consensus on public financing into commitment by G8 to prioritize support to countries that prioritize public financing Support for countries that abolish user fees, starting with MDG 4, 5 and 6 services Coherent message through IHP+ and P4H 3. Invest in the ability of developing country partners to make better health financing policy through investing in national policy capacity, supporting countries to share best practices 13

8 Global Financial Crisis Crisis in market institutions often generates the political and intellectual window for better health financing Japan, Sri Lanka (1930s), Thailand/Indonesia (1990s), USA (2009) 2008 crisis different to the 1980s Requires boosting consumption and spending globally Need for structural shift from savings to consumption in many developing Asian countries Mutual interest of G8 and developing country partners in an open global economy In a crisis, workers cannot fall back on private financing Publicly-financed social protection can play its role in maintaining support in hardest-hit economies 14 Next Steps Build consensus for 2009 G8 meeting Bridging US and partner positions and consolidating EU partners Building on the joint interests of civil society, G8 governments and developing countries Make good use of financial crisis Window opening for changes in policy assumptions and for increased spending Changed reality of Obama administration Impact on policy debates on role of state, and importance of better value in health systems Possibility of unified G8 position 15